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NPI Code Detail

MEDICARE: FUNKEYE LLC

MEDICARE: FUNKEYE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

General Provider Information

NPI Number : 1346514031
Entity Type Code : Organization
Provider Name (Legal Business Name) : FUNKEYE LLC
Provider Business Mailing Address
First Line : 1200 N EAST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-2432
Country : US
Telephone Number : 618-395-5222
Fax Number : 618-395-8552
Provider Business Practice Location Address
First Line : 1200 N EAST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-2432
Country : US
Telephone Number : 618-395-5222
Fax Number : 618-395-8552
Authorized Official
Title or Position : OWNER
Name : DR. TINA M. FUNK
Credential : O.D.
Telephone Number : 618-395-5222
Provider Enumeration Date : 02/28/2012
Last Update Date : 03/01/2012

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Directions to “FUNKEYE LLC ” Practice Location

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